Roa, Josefina Carmen P.

May 21, 2021

Activity No. 6
Management of Poisoning
(Central Nervous System Involvement)

1. Explain how poisons cause:

a. Convulsions
b. Coma

Some chemicals interact directly with neurotransmitter receptors, including (1) agonists
that associate with the ligand-binding site on the receptor and mimic the natural ligand, (2)
antagonists that occupy the ligand-binding site but cannot activate the receptor, (3) activators,
and (4) inhibitors that bind to a site on the receptor that is not directly involved in ligand binding.
In the absence of other actions, agonists and activators mimic, whereas antagonists and
inhibitors block, the physiologic responses characteristic of endogenous ligands. For example,
muscimol, a mushroom poison, is an agonist at the inhibitory GABA A receptor, whereas
barbiturates, benzodiazepines, general anesthetics, and alcohols are. Thus, all these chemicals
cause inhibition of central nervous system activity, resulting in sedation, general anesthesia,
coma, and ultimately blockade of the medullary respiratory center, depending on the dose
administered.
There are also similarities in the responses evoked by agonist/activators on excitatory
receptors and those elicited by antagonists/inhibitors on inhibitory sites. Thus, glutamate
receptor agonists and muscarinic receptor agonists cause neuronal hyperactivity in the brain
and ultimately convulsions, as do inhibitors of GABA A receptor. It is also apparent that
chemicals acting as agonists/activators on inhibitory receptors and those acting as
antagonists/inhibitors on excitatory receptors may exert similar effects. Moreover, general
anesthetic solvents induce general anesthesia not only by activating the inhibitory ligand-gated
chloride-ion channels (ie, GABA A and glycine receptors) but also by inhibiting the excitatory
ligand-gated cation channels.

2. Define:
a. Hyperactivity – means a person seems to move about constantly, including in situations
in which it is not appropriate; or excessively fidgets, taps, or talks. In adults, it may be
extreme restlessness or wearing others out with constant activity.
b. Delirium – an acutely disturbed state of mind that occurs in fever, intoxication, and
other disorders and is characterized by restlessness, illusions, and incoherence of
thought and speech.
c. Mania – a mental illness marked by periods of great excitement or euphoria, delusions,
and over activity.

3. For each symptom, provide the following

 Emergency Measures General Measures Specific Measures
a. Coma Doctors will first check Initial management Dextrose, thiamine,
the affected person's according to the and the opiate
airway and help needs (A) antagonist naloxone
maintain breathing and maintenance of a have been labeled as
circulation. Doctors free airway, (B) a coma cocktail and
might give breathing support of breathing routinely advocated
assistance, intravenous with artificial in coma patients.
medications and other ventilation and (C) More recently, the
supportive care. support of benzodiazepine
Treatment varies, circulation with e.g., receptor antagonist
depending on the cause intravenous fluids flumazenil has also
of the coma. and vasopressors to been considered as
maintain blood an urgent antidote.
pressure and
adequate cerebral
perfusion.
b. Convulsions Treatment usually Stay calm and Place something soft
involves IV (or oral remain with the under his or her head.
medication in some person. If they have Loosen tight
people) medication such food or fluid in their neckwear. Avoid
as lorazepam; other mouth, roll them putting your fingers
drugs may also be onto their side or other objects in
utilized with this drug immediately. Keep the person's mouth.
type (phenytoin or them safe and Don't try to restrain
fosphenytoin). protect them from someone having
Treatment is needed to injury. a seizure.
begin soon as
continual seizures lasting
20-30 min. may result in
damage to the brain.
c. Mania, delirium coordinating the care of The environment is Haloperidol,
and hyperactivity the patient with other kept as quiet and Benzodiazepines,
clinicians; identifying the calm as possible. It Barbiturates, and
underlying cause(s) of should be well-lit to other antipsychotic
the delirium; initiating enable people to drugs
immediate interventions recognize what and
for urgent general who is in their room
medical conditions; and where they are.
providing treatments Placing clocks,
that address the calendars, and
underlying etiology of family photographs
the delirium; assessing in the room can
and ensuring the safety help with
of the patient and others orientation. At
every opportunity,
 staff and family
members should
reassure people and
remind them of the
time and place.
Procedures should
be explained before
and as they are
done. People who
need glasses or
hearing aids should
have access to
them.

References:

Klaassen, C.D. 2013. Casarett & Doull’s Toxicology: The Basic Science of Poison. 8th Edition. Toxicant-
Neurotransmitter Receptor Interactions. P77

Buylaert, W. A. 2000. Coma Induced by Intoxication. Acta Neurol. Belg. P222. Retrieved from
https://www.actaneurologica.be/pdfs/2000-4/03-buylaert.pdf

Trzepacz, P. et al, 1999. Practice Guide for the treatment of Patients with Delirium. P9. Retrieved from
https://psychiatryonline.org/pb/assets/raw/sitewide/practice_guidelines/guidelines/delirium.pdf